Define term the term fracture, dislocation and Subluxation

Identify the general causes, signs , symptoms of fractures

Classify the different types of fractures

Learning Objectives

With the end of the lecture the student should be able to:-

What is fracture(#)?

common causes of fractures:

Fall from a height

car accidents

Direct blow

Repetitive forces

Pathology

a BREECH in the continuity of a bone

Swelling or OEDEMA pain and tenderness Numbness Bleeding Broken skin with bone protruding Limitation to move a limb

Signs and Symptoms

CLASSIFICATION OF

FRACTURES

Why Classify?

• As a treatment guide• To assist with

prognosis• To speak a common

language with other surgeons

As a Treatment Guide

• If the same bone is broken, the surgeon can use a standard treatment

• PROBLEM: fracture personality and variation with equipment and experience

To Assist with Prognosis

• You can tell the patient what to expect with the results

• PROBLEM: Does not consider the soft tissues or other compounding factors

To Speak A Common Language

• This will allow results to be compared

• PROBLEM: Poor interobserver reliability with existing fracture classifications

Intraobserver Reliability

For a given fracture, each physician should produce the same classification

CLASSIFICATION

• Based on Relationship with the environment• Based on Displacement• Based on Fracture pattern • Based on Etiology

CLASSIFICATION

Based on relationship with the environment

1. CLOSED { Simple}2. OPEN {Compound} – within _ without

Closed Fractures

• Fracture is not exposed to the environment

• All fractures have some degree of soft tissue injury

• Don’t underestimate the soft tissue injury as this affects treatment and outcome!

Open Fractures

• A break in the skin and underlying soft tissue leading to a communicating fracture hematoma

Gustillo classification

• The Gustillo classification is used to classify open fracture - ones in which the skin has been disrupted

• Three grades that try to quantify the amount of soft tissue damage associated with the fracture

Grade 1— <1cm wound Grade2 — >1cm wound Grade 3— subgrades A,B,C

CLASSIFICATION

Based on Displacement

1. UNDISPLACED2. DISPLACED – • Initial impact• Pull of surrounding muscles / gravity

Displacement - Translation

• Translation is sideways motion of the fracture - usually described as a percentage of movement when compared to the diameter of the bone -- ----------direction of distal fragment decides

Displacement - Angulation

• Angulation is the amount of bend at a fracture described in degrees. Described with respect to the apex of the angle .

Displacement - Shortening

• Shortening is the amount a fracture is collapsed/ shifted proximally, expressed in centimeters.

CLASSIFICATION

Based on fracture pattern 1. Transverse2. Oblique3. Spiral4. Comminuted5. Segmental6. Stellate

Transverse Fracture A fracture in which the # line is perpendicular to the long axis of the bone .

Oblique Fracture A fracture in which the # line is at oblique angle to the long axis of the bone.

According to the Path of the # Line

Fracture Types

Spiral Fracture A severe form of oblique fracture in which the # plane rotates along the long axis of the bone. These #s occur secondary to rotational force.

According to the Path of the # Line

Fracture Types

Anatomical classification of fracturesFractures

Comminuted # : The bone is broken into many fragments.

Stellate fracture: This # occurs in the flat bones of the skull and in the patella, where the fracture lines run in various directions from one point.

CLASSIFICATION

Based on etiology

1. TRAUMATIC2. PATHOLOGICAL

CLASSIFICATION

PATHOLOGICAL • --- Tumors• --- Bone cysts• --- Osteomyelitis• --- Osteoporosis• --- Osteogenesis imperfecta• --- Rickets etc

AO/OTA Classification

• Describing the fracture localization: bones and segments

• 1Humerus• 2Radius/ulna• 3Femur• 4Tibia/fibula

AO/OTA Classification

• The identification of the respective segment needs a little more consideration. Each long bone has three segments:

• 1 Proximal end segment• 2 Diaphyseal segment• 3 Distal end segment

CLASSIFICATION

Based on eponyms : • Colles’ # :: Dinner fork deformity• Monteggia # D/L :: # proximal 1/3 shaft ulna

with dislocation of head of radius• Galeazzi # D/L :: # Distal 1/3 shaft Radius with

dislocation of distal radioulnar joint• Jone’s # :: Avulsion # of base of 5th metatarsal• Green stick # :: unicortical # with bent bones in

children

Anatomical classification of fractures

Impacted fracture: This # where a vertical force drives the distal fragment of the fracture into the proximal fragment.

Fracture Types

Depressed fracture: This # occurs in the skull where a segment of bone gets depressed into the cranium.

Avulsion fracture: This is one, where a chip of bone is avulsed by the sudden and unexpected contraction of a powerful muscle from its point of insertion, Examples1. ASIS Avulsion2. JONE’S 5th MT base Avulsion

Fracture TypesAnatomical classification of fractures

• Stress fracture : • It is a fracture occurring at a site in the bone subject to

repeated minor stresses over a period of time.

• Birth fracture: • It is a fracture in the new born children due to injury during birth

History of Fracture Classification

• 18th & 19th century– History based on

clinical appearance of limb alone

Colles Fracture Dinner Fork Deformity

Salter-Harris Classification

• Only used for pediatric fractures that involve the growth plate (physis)

• Five types (I-V)

Salter-Harris type I fracture

• Type I fracture is when there is a fracture across the physis with no metaphysial or epiphysial injury

Salter-Harris type II fracture

• Type II fracture is when there is a fracture across the physis which extends into the metaphysis

Salter-Harris type III fracture

• Type III fracture is when there is a fracture across the physis which extends into the epiphysis

Salter-Harris type IV fracture

• Type IV fracture is when there is a fracture through metaphysis, physis, and epiphysis

Salter-Harris type V fracture

• Type V fracture is when there is a crush injury to the physis

What about CT scans & MRI ?

• CT scanning can assist with fracture classification

• Example: Sanders classification of calcaneal fractures

 What is Dislocation?

Joints Dislocation

Is the total displacement of the articular end of a bone from the joint cavity.

Subluxation : Is an incomplete displacement.Reduction : Is the restoration of the normal alignment of the bones.

Classification: Dislocations are classified as follows:

A. Congenital

B. Traumatic

C. Pathological

D. Paralytic

PIP Joint Subluxation Elbow joint Dislocation.

Dislocation & Subluxation(Sample Radiographs)

Thank You!